Provider Demographics
NPI:1376543587
Name:XENIA TOWNSHIP BOARD OF TRUSTEES
Entity Type:Organization
Organization Name:XENIA TOWNSHIP BOARD OF TRUSTEES
Other - Org Name:XENIA TOWNSHIP FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:BEEGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-372-7857
Mailing Address - Street 1:PO BOX 2064
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-7264
Mailing Address - Country:US
Mailing Address - Phone:937-424-3701
Mailing Address - Fax:937-291-2971
Practice Address - Street 1:8 BRUSH ROW RD
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-8599
Practice Address - Country:US
Practice Address - Phone:937-372-7857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-0758950341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000350732OtherANTHEM
OHP00309987OtherRAILROAD MEDICARE
OH2531657Medicaid
OHP00309987OtherRAILROAD MEDICARE